Hep A&B - EG Flashcards
How is Hep A transmitted?
person to person
ingestion
what are the 3 stages of Hep A?
incubation: 28 days
acute hepatitis 2-3 wks
convalescence: 9 wks
Signs and sxs for Hep A&B
prodrome of anorexia, N/V, malaise, aversion to smoking
Fever, enlarged/tender liver, jaundice
normal to low WBC count, markedly elevated aminotransferases
Tx for Hep A
immune globulin
handwashing
When is the vaccine for Hep A typically given?
2 doses at 0 mo’s and 6-18 mo’s
When is IVIG indicated and when is it effective to use?
when the vaccine is NOT an option
- post-exposure prophylaxis (dose = 0.02)
- short-term preexposure coverage < 3 mo’s (dose = 0.02)
- long-term pre-exposure prophylaxis of <5 mo’s (dose = 0.06)
When should you give post-exposure prophylaxis w/ the vaccine?
recent HAV exposure
Who should receive Ig prophylaxis?
< 12 mo’s or >40 y/o with one of the following:
- immunocompromised
- chronic liver dz
- underlying medical conditions when vaccine is contraindicated
T or F: Patients who receive at least one dose of the HAV vaccine at least 1 mo prior to exposure do not need preexposure or post-exposure prophylaxis w/ Ig.
FACT.
How is Hep B transmitted?
sexually, parenterally, perinatally (saliva, semen, vaginal secretions)
What pt population is at high risk for chronic infx and what conditions are they at an increased risk for?
infants and children
cirrhosis and hepatocellular carcinoma (25-40% and M>W)
Treatment for Hep B
supportive = IVIG for acute exposure
preventative = vacine at 0 mo, 1 mo, 6 mo’s
chronic = interferons, antivirals
T or F: antivirals can be used to treat Hep A and B?
FALSE.
NOT used for Hepatitis A
Which vaccines are included in the combination vaccine used in infants for HBV?
Hep B + DTaP + HIB = combo vaccine
*complete course beginning after infant is equal to or >6 wks of age
When should infants receive the 1st dose of Hep B vaccine if their mother is HBsAg-positive?
w/in first 12 hrs of life, hepatitis immune globulin should also be administered at the same time at a different site
when should Infants w/mother HBsAg status unknown receive the 1st dose of Hep B vaccine?
within 12 hrs of birth
serologic testing and revaccination may be necessary for which pt’s?
pt’s renal impairment 1-2 mo’s after final dose of primary vaccine series
contraindications/ADE’s/Interactions
hypersensitivity
syncope
dermatologic - angioedema
immunosuppressants - may diminish the therapeutic effect of vaccines (inactivated)
Chronic hepatitis B treatment?
Chronic: INF and antivirals (Entecovir, Tenofovir)
may require long-term therapy but this could lead to resistance (esp. to lamivudine and telbivudine) w/ less resistance to tenofovir
what are some recommendations for a pt w/ HBV?
vaccinate sexual and household contacts avoid alcohol milk thistle (not w/antiviral tx)
When should a pt w/chronic HBV and HBsAg+ receive immediate tx?
if jaundice or decompensation
goal of tx for HBV
hepatic damage is sustained by ongoing viral replication
suppress w/drug therapy by either immunomodulating agents or antivirals
What are 3 agents used to tx chronic HBV?
entecavir
tenocavir disoproxil
interferon alpha-2b
Entecavir ADE’s
lactic acidosis*
HA, fatigue, upper abd pain
Tenofovir ADE’s
Nephropathy & lactic acidosis *
N, abd pain, fatigue
Interferon alpha-2b ADE’s
flu-like sxs & cytopenias *
mood disturbances, autoimmune disorders
What lab should you monitor for HBV therapy?
ALT
Adefovir ADEs
Renal dysfunction, lactic acidosis
